Matsumori Akira, Shimada Toshio, Chapman Nora M, Tracy Steven M, Mason Jay W
Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
J Card Fail. 2006 May;12(4):293-8. doi: 10.1016/j.cardfail.2005.11.004.
The aim of study is to determine the prevalence of hepatitis C virus (HCV) infection and myocardial injury among patients enrolled in the Myocarditis Treatment Trial. HCV infection has recently been noted in patients with cardiomyopathies and myocarditis. However, prevalence of HCV infection in myocarditis and heart failure remains to be clarified.
Patients with heart failure up to 2 years in duration without a distinct cause were enrolled in the trial between 1986 and 1990. Frozen blood samples were available from 1355 among 2233 patients enrolled and examined for presence of anti-HCV antibodies, circulating cardiac troponins I and T, and N-terminal pro-brain natriuretic peptide (NT-proBNP). Anti-HCV antibodies were identified in 59 of 1355 patients (4.4%). This higher prevalence of HCV infection than that observed in the general US population (1.8%), varied widely (0-15%) among the different medical centers and regions. The concentrations of circulating cardiac troponin (cTn) I were elevated in 17 of 56 patients (30%), and cTnT was detectable in 28 of 59 patients (48%) with HCV antibodies, suggesting the persistence of ongoing myocardial injury. The concentrations of NT-proBNP were elevated in 42 of 42 patients (100%) with HCV antibodies, (10,000 +/- 5860 pg/mL), a mean value significantly greater than in 1276 patients without HCV antibody (2508 +/- 160 pg/mL, P < .0001).
Anti-HCV antibodies were identifiable in sera stored for 13 to 17 years and were more prevalent in patients with myocarditis and HF than in the general population. In regions where its prevalence is high, HCV infection may be an important cause of myocarditis and HF. NT-proBNP is a more sensitive marker of myocardial injury than cardiac troponins in patients with heart failure from HCV myocarditis.
本研究旨在确定参与心肌炎治疗试验的患者中丙型肝炎病毒（HCV）感染和心肌损伤的患病率。近期在心肌病和心肌炎患者中发现了HCV感染。然而，心肌炎和心力衰竭患者中HCV感染的患病率仍有待明确。
1986年至1990年间，将病程长达2年且无明确病因的心力衰竭患者纳入该试验。在纳入的2233例患者中，有1355例患者留存了冷冻血样，检测抗HCV抗体、循环心肌肌钙蛋白I和T以及N末端脑钠肽前体（NT-proBNP）。1355例患者中有59例（4.4%）检测出抗HCV抗体。该HCV感染患病率高于美国普通人群（1.8%），且在不同医疗中心和地区差异很大（0 - 15%）。56例患者中有17例（30%）循环心肌肌钙蛋白（cTn）I浓度升高，59例抗HCV抗体阳性患者中有28例（48%）可检测到cTnT，提示存在持续性心肌损伤。42例抗HCV抗体阳性患者（100%）的NT-proBNP浓度升高（10,000 ± 5860 pg/mL），其平均值显著高于1276例无HCV抗体患者（2508 ± 160 pg/mL，P <.0001）。
在储存了13至17年的血清中可检测到抗HCV抗体，且心肌炎和心力衰竭患者中的患病率高于普通人群。在患病率较高的地区，HCV感染可能是心肌炎和心力衰竭的重要病因。对于HCV心肌炎所致心力衰竭患者，NT-proBNP是比心肌肌钙蛋白更敏感的心肌损伤标志物。
